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Bleeding
Kinds of Bleeding Terms modified by Bleeding Selected AbstractsCURRENT STATUS IN THE OCCURRENCE OF POSTOPERATIVE BLEEDING, PERFORATION AND RESIDUAL/LOCAL RECURRENCE DURING COLONOSCOPIC TREATMENT IN JAPANDIGESTIVE ENDOSCOPY, Issue 4 2010Shiro Oka Bleeding, perforation, and residual/local recurrence are the main complications associated with colonoscopic treatment of colorectal tumor. However, current status regarding the average incidence of these complications in Japan is not available. We conducted a questionnaire survey, prepared by the Colorectal Endoscopic Resection Standardization Implementation Working Group, Japanese Society for Cancer of the Colon and Rectum (JSCCR), to clarify the incidence of postoperative bleeding, perforation, and residual/local recurrence associated with colonoscopic treatment. The total incidence of postoperative bleeding was 1.2% and the incidence was 0.26% with hot biopsy, 1.3% with polypectomy, 1.4% with endoscopic mucosal resection (EMR), and 1.7% with endoscopic submucosal dissection (ESD). The total incidence of perforation was 0.74% (0.01% with the hot biopsy, 0.17% with polypectomy, 0.91% with EMR, and 3.3% with ESD). The total incidence of residual/local recurrence was 0.73% (0.007% with hot biopsy, 0.34% with polypectomy, 1.4% with EMR, and 2.3% with ESD). Colonoscopic examination was used as a surveillance method for detecting residual/local recurrence in all hospitals. The surveillance period differed among the hospitals; however, most of the hospitals reported a surveillance period of 3,6 months with mainly transabdominal ultrasonography and computed tomography in combination with the colonoscopic examination. [source] MANAGEMENT OF OBSCURE GASTROINTESTINAL BLEEDING BASED ON THE CLASSIFICATION OF CAPSULE ENDOSCOPIC BLEEDING FINDINGSDIGESTIVE ENDOSCOPY, Issue 3 2010Mitsunori Maeda Background:, Double-balloon endoscopy (DBE) and capsule endoscopy (CE) have been useful in managing obscure gastrointestinal bleeding (OGIB). However, DBE is invasive, complex and time-consuming, therefore indications should probably be selective. The aim of this study was to evaluate the usefulness of the classification of the CE bleeding findings for determining the indications and timing of DBE in patients with OGIB. Methods:, From February 2003 to January 2009, 123 patients with OGIB who underwent CE were included in this study. These CE findings were classified based on the bleeding source. Type CE-I, II, III, IV and 0 indicate active bleeding, previous bleeding, lesions without active bleeding, a lesion outside of the small bowel, and no findings, respectively. We compared diagnostic yield and outcome between the classification and the findings of DBE or enteroclysis. Results:, Comparisons of the positive findings rate with DBE or enteroclysis, the treatment rate and the rebleeding rate with the classification showed: CE-Ia, 100% (6/6), 50% (3/6), 33.3% (2/6); Ib, 66.7% (4/6), 0% (0/6), 16.7% (1/6); IIa, 33.3% (1/3), 33.3% (1/3), 33.3% (1/3); IIb, 53.8% (7/13),15.4% (2/13), 30.8% (4/13); III, 100% (84/84), 9.5% (8/84), 8.3% (7/84); IV, 100% (2/2), 50% (1/2), 0% (0/2); and 0, 0% (0/9), 0% (0/9), 0% (0/9), respectively. Conclusions:, The proportion of patients requiring treatment, the positive findings rate with DBE or enteroclysis and the rebleeding rates tended to be higher in the higher ranked classification types (CE-I > II > III > IV > 0). These findings suggest that the classification can provide useful information on determining the indications and timing of DBE. [source] PEUTZ,JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERYDIGESTIVE ENDOSCOPY, Issue 1 2003Kazuhiro Yada We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz,Jeghers (P,J) polyposis successfully treated by laparoscopic surgery. A 49-year-old woman was admitted for severe cough and edema of the extremities. Chest X-ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc-diethylene triamine penta-acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy-assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P,J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P,J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding. [source] PROGNOSIS OF UPPER GASTROINTESTINAL BLEEDING IN THE OLDEST-OLD PATIENTS: A POST HOC ANALYSIS OF A PROSPECTIVE STUDYJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2010Stéphane Nahon MD No abstract is available for this article. [source] Interactive Volume Rendering with Dynamic Ambient Occlusion and Color BleedingCOMPUTER GRAPHICS FORUM, Issue 2 2008Timo Ropinski Abstract We propose a method for rendering volumetric data sets at interactive frame rates while supporting dynamic ambient occlusion as well as an approximation to color bleeding. In contrast to ambient occlusion approaches for polygonal data, techniques for volumetric data sets have to face additional challenges, since by changing rendering parameters, such as the transfer function or the thresholding, the structure of the data set and thus the light interactions may vary drastically. Therefore, during a preprocessing step which is independent of the rendering parameters we capture light interactions for all combinations of structures extractable from a volumetric data set. In order to compute the light interactions between the different structures, we combine this preprocessed information during rendering based on the rendering parameters defined interactively by the user. Thus our method supports interactive exploration of a volumetric data set but still gives the user control over the most important rendering parameters. For instance, if the user alters the transfer function to extract different structures from a volumetric data set the light interactions between the extracted structures are captured in the rendering while still allowing interactive frame rates. Compared to known local illumination models for volume rendering our method does not introduce any substantial rendering overhead and can be integrated easily into existing volume rendering applications. In this paper we will explain our approach, discuss the implications for interactive volume rendering and present the achieved results. [source] CURRENT STATUS IN THE OCCURRENCE OF POSTOPERATIVE BLEEDING, PERFORATION AND RESIDUAL/LOCAL RECURRENCE DURING COLONOSCOPIC TREATMENT IN JAPANDIGESTIVE ENDOSCOPY, Issue 4 2010Shiro Oka Bleeding, perforation, and residual/local recurrence are the main complications associated with colonoscopic treatment of colorectal tumor. However, current status regarding the average incidence of these complications in Japan is not available. We conducted a questionnaire survey, prepared by the Colorectal Endoscopic Resection Standardization Implementation Working Group, Japanese Society for Cancer of the Colon and Rectum (JSCCR), to clarify the incidence of postoperative bleeding, perforation, and residual/local recurrence associated with colonoscopic treatment. The total incidence of postoperative bleeding was 1.2% and the incidence was 0.26% with hot biopsy, 1.3% with polypectomy, 1.4% with endoscopic mucosal resection (EMR), and 1.7% with endoscopic submucosal dissection (ESD). The total incidence of perforation was 0.74% (0.01% with the hot biopsy, 0.17% with polypectomy, 0.91% with EMR, and 3.3% with ESD). The total incidence of residual/local recurrence was 0.73% (0.007% with hot biopsy, 0.34% with polypectomy, 1.4% with EMR, and 2.3% with ESD). Colonoscopic examination was used as a surveillance method for detecting residual/local recurrence in all hospitals. The surveillance period differed among the hospitals; however, most of the hospitals reported a surveillance period of 3,6 months with mainly transabdominal ultrasonography and computed tomography in combination with the colonoscopic examination. [source] Spontaneous intracerebral hemorrhage in young adultsEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2005S.-L. Lai Few studies have addressed intracerebral hemorrhage (ICH) in younger adults. We studied spontaneous ICH in adults ,45 years of age. We retrospectively reviewed patients hospitalized with ICH between 2000 and 2001 to investigate incidence, etiology, risk factors, bleeding sites, management, and prognosis. Patients (224 men, 72 women; 37.0 ± 7.7 years) had a mortality rate of 24%. The most common risk factor for mortality was hypertension (HTN) (48.7%). Bleeding was most common in the ganglion (49.0%). Multiple hemorrhages (83.3%) caused the highest mortality, with the most common cause of mortality being HTN (46.6%). Coagulopathy (62.5%) caused the highest mortality based on etiologic classification. Recurrent HTN-induced hemorrhage rate was 3.6%. In Taiwanese adults ,45 years of age, ICHs mainly involve the ganglion and result from HTN. Rates of HTN-induced hemorrhage are higher in Taiwan (46.6%) than elsewhere. Differences between races or countries should be investigated further. [source] FEIBA® in treatment of acute bleeding episodes in patients with haemophilia A and factor VIII inhibitors: a retrospective survey in regional haemophilia centreHAEMOPHILIA, Issue 3 2009P. SMEJKAL Summary., FEIBA® (factor eight inhibitor by-passing activity) is used to achieve haemostasis in haemophiliacs with inhibitor. The aim of this study was to evaluate efficacy and consumption of the product in treatment of haemorrhages in haemophiliacs with factor VIII inhibitor, and determine factors that can influence the results of treatment. We used data from our haemophilia centre from years 2000,2008. Six haemophiliacs with factor VIII inhibitor were treated on demand with FEIBA® for 61 bleeding episodes (45 haemarthroses, six muscle bleeds, six other sites bleeds and four multiple sites bleeds). The median cumulative dose of FEIBA® per bleeding episode was 205 U kg,1. Bleeding was stopped in 96.7% (59 of 61) of events but re-bleeding occurred in 3 events (4.9%) within 48 h after cessation of bleeding. In home treatment (20 of 61) bleeding stopped in 90% (18 of 20) without recurrence and the median consumption per event was reduced to 153 U kg,1. Without the use of home treatment the median consumption was 250 U kg,1 per event and bleeding ceased definitely in 92.7% (38 of 41) of cases. The cumulative dose of FEIBA® was lower for three episodes with re-bleeding: median 96 U kg,1 but not in the two cases of ineffective treatment: 361 U kg,1. FEIBA® in management of bleeding episodes completely resolved the haemorrhage in 91.8% of events and in a further 4.9% if treatment was restarted. Using home treatment saved expenditure due to the lower cumulative dose needed for treatment of haemorrhage. [source] Applicability and safety of recombinant activated factor VII to control non-haemophilic haemorrhage: investigational experience in 265 childrenHAEMOPHILIA, Issue 4 2008M. HERBERTSON Summary., Experience of recombinant activated factor VII (rFVIIa, NovoSeven®; Novo Nordisk A/S, Bagsvaerd, Denmark) to control haemorrhage in non-haemophilic children is limited. The object of this study was to examine the applicability and safety of rFVIIa amongst a group of non-haemophilic paediatric subjects. Details of all non-haemophilic children ,16 years receiving rFVIIa whose data were recorded in the investigational, internet-based registry, haemostasis.com were analysed. A total of 265 children (mean age 7.7 years) were treated with rFVIIa; the median dose administered was 78.4 ,g kg,1 body weight (range 9.0,393.4) and the median total dose received 100.0 ,g kg,1 body weight (range 10.9,1341.2). Therapeutic areas included surgery (34.5%), coagulopathy (including thrombocytopenia; 29.0%), spontaneous bleeding (17.2%), trauma (8.4%) and intracranial haemorrhage (4.5%). Two patients experienced thromboembolic events following administration of rFVIIa. Thirty-nine patients died on account of haemorrhage or complications relating to their underlying condition; neither the thromboembolic events nor the deaths were related to rFVIIa administration. Bleeding stopped in 118/237 (49.8%), markedly decreased in 54/237 (22.8%), decreased in 51/237 (21.5%), remained unchanged in 13/237 (5.5%) and increased in 1/237 (0.4%) patients. These results suggest that rFVIIa is safe and widely applicable in children to control non-haemophilic haemorrhage. [source] Continuous infusion of factor concentrates in children with haemophilia A in comparison with bolus injectionsHAEMOPHILIA, Issue 3 2006C. BIDLINGMAIER Summary., Although the concept of continuous infusion (CI) of factor concentrates is well known, prospective paediatric data are rare. We present a prospective open-labelled non-randomized study focusing on safety, efficacy and factor VIII (FVIII) usage compared with bolus injections (BI) in children. In 43 consecutive patients (0.5,17 years; median: 9.6) undergoing different operations, CI was started with an initial FVIII-bolus of 70 IU kg,1 bodyweight, followed by a median infusion rate of 4.4 IU kg,1 h,1 (range: 2.8,9.5) dose adjusted for daily FVIII levels (target: 60,80%). No direct serious adverse events occurred; however, two out of 43 patients, both from the group of four patients with less than 20 exposure days (ED) before starting CI, developed a high-responding inhibitor. Two CI patients showed mild thrombophlebitis or rash. Infusion rates needed to achieve adequate FVIII levels were highly predictable and could be reduced because of decreasing FVIII clearance. Bleeding, requiring additional boli, was observed in eight out of 43 patients. Therapy duration and factor usage of CI were influenced by the procedure, but not by the product used or thrombophilia. Twelve of these CI patients were compared with 12 contemporary consecutive age- and procedure-matched BI patients. Compared with BI patients, CI patients saved 30% FVIII (812.9 vs. 563.2 IU kg,1, P < 0.006). We conclude that CI forms a safe and effective method for perioperative care in children and reduces factor usage. Because of the unknown risk of inhibitor development, we will use CI only in patients beyond 20 ED. [source] Experimental haemophilic synovitis: rationale and development of a murine model of human factor VIII deficiencyHAEMOPHILIA, Issue 3 2004L. A. Valentino Summary., Haemophilia is a genetic disease as a result of the deficiency of blood coagulation factor VIII or IX. Bleeding is common, especially into joints where an inflammatory, proliferative synovitis develops resulting in a debilitating arthritis, haemophilic arthropathy. The pathogenesis of blood-induced haemophilic synovitis (HS) is poorly understood. The gross, microscopic and ultrastructural changes that occur in the synovial membrane following human and experimental hemarthrosis have been described. Repeated episodes of bleeding induce synoviocyte hypertrophy and hyperplasia, an intense neovascular response and inflammation of the synovial membrane. The component(s) in blood that initiates these changes is(are) not known, although iron is often proposed as one possibility. Here, we describe a novel murine model of human haemophilia A, which facilitates the examination of large number of animals and tissue specimens. The effects of hemarthrosis on the physical, gross and microscopic changes evoked following joint bleeding are described. Controlled, blunt trauma to the knee joint consistently resulted in joint swelling because of a combination of bleeding and inflammation. Hemosiderin was found in the synovial membrane. Similar to hemarthrosis in human haemophilia, joint bleeding resulted in acute morbidity evidenced by inactivity, weight loss and immobility. With time the animals recovered. The model of experimental murine HS described here has utility in the study of the pathogenesis of HS. This is the first of a series of articles, which will discuss the pathophysiology and characterize the model, with comparison of his model to others which have been published previously. It should provide a useful model to test potential therapeutic interventions. [source] Continuous factor VIII infusion therapy in patients with haemophilia A undergoing surgical procedures with plasma-derived or recombinant factor VIII concentratesHAEMOPHILIA, Issue 5 2002D. Dingli Summary., We describe the experience of a single medical centre with continuous factor VIII (FVIII) infusion therapy in a cohort of patients undergoing elective surgery. Twenty-eight patients had a total of 45 procedures. Intraoperative haemostasis was considered excellent in all 45 cases. FVIII levels were maintained between 46% and 191% of normal (median, 103%) for 2,7 days. Bleeding occurred after five procedures (11%) at times when factor VIII levels were within haemostatic range. No patient required reoperation to control bleeding. There were no cases of sepsis related to continuous infusion of factor VIII. We conclude that continuous infusion: (1) is a safe and effective means of replacement therapy in patients with haemophilia undergoing surgery; (2) provides easier monitoring and more constant coagulation factor levels; and (3) has the potential to decrease the cost of replacement therapy by reducing overall usage of product. [source] Immediate haemostasis with recombinant factor VIIa for haemorrhage following Hickman line insertion in acute myeloid leukaemiaINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 3 2004W. Osborne Summary Bleeding following Hickman line insertion is not uncommon but can be life threatening, especially in the presence of coagulopathy and thrombocytopenia following chemotherapy. Treatment to control the bleeding can be challenging and treatment options are limited. We present our experience of a patient who had persisting haemorrhage immediately following Hickman line insertion for administration of chemotherapy for relapsed acute myeloid leukaemia. Haemostasis could not be achieved after FFP and platelet administration. A single dose of recombinant factor VIIa (rhFVIIa) stopped the bleeding immediately, avoiding the need for surgical intervention or line removal. Our experience indicates rhFVIIa may be an effective option for bleeding related to Hickman line insertion. [source] Clinical approach to the patient with unexpected bleedingINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 2000J. M. Teitel Bleeding can be considered unexpected if it is disproportionate to the intensity of the haemostatic stress in a patient with no known haemorrhagic disorder or if it occurs in a patient in whom a bleeding disorder has been characterized but is adequately treated. A thorough history usually allows the clinician to predict reasonably accurately whether the patient is likely to have a systemic haemostatic defect (and if so whether it is congenital or acquired), or whether the bleeding likely has a purely anatomical basis. The nature of bleeding is instructive with respect to preliminary categorization. Thus, mucocutaneous bleeding suggests defects of primary haemostasis (disordered platelet,vascular interactions). Bleeding into deeper structures is more suggestive of coagulation defects leading to impaired fibrin clot formation, and delayed bleeding after primary haemostasis is characteristic of hyperfibrinolysis. Localized bleeding suggests an anatomical cause, although an underlying haemostatic defect may coexist. Where bleeding is so acutely threatening as to require urgent intervention, diagnosis and treatment must proceed simultaneously. In the case of minor haemorrhage (not threatening to life or limb) it may be preferable to defer therapy while the nature of the bleeding disorder is methodically investigated. Initial laboratory evaluation is guided by the preliminary clinical impression. The amount of blood loss can be inferred from the haematocrit or haemoglobin concentration, and the platelet count will quickly identify cases in which thrombocytopenia is the likely cause of bleeding. In the latter instance, examination of the red cell morphology, leucocyte differential, and mean platelet volume may allow the aetiological mechanism to be presumptively identified as hypoproliferative or consumptive. With regard to coagulation testing, the activated PTT, prothrombin time, and thrombin time usually constitute an adequate battery of screening tests, unless the clinical picture is sufficiently distinctive to indicate the immediate need for more focused testing. In any event, sufficient blood should be taken to allow more detailed studies to be done based on the results of these screening tests. These results will direct the need for further assays, such as specific clotting factor activity levels, von Willebrand factor assays, tests for coagulation inhibitors, platelet function assays, and markers of primary or secondary fibrinolytic activity. [source] Simplified treatment of massive rectal bleeding following prostate needle biopsyINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2004MURAT GONEN Abstract Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound-guided prostate biopsy, but it usually stops spontaneously. We report a case of life-threatening rectal bleeding following this procedure. Bleeding was controlled using an ordinary condom, which was successfully inflated in the rectum over the bleeding site. [source] Connective tissue graft plus resin-modified glass ionomer restoration for the treatment of gingival recession associated with non-carious cervical lesion: a randomized-controlled clinical trialJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2009Mauro Pedrine Santamaria Abstract Background: The aim of this clinical study was to evaluate the treatment of gingival recession, associated with non-carious cervical lesions by a connective tissue graft (CTG) alone, or in combination with a resin-modified glass ionomer restoration (CTG+R). Materials and Methods: Forty patients presenting Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects were randomly assigned to receive either CTG or CTG+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at baseline and 45 days, and 2, 3 and 6 months after treatment. Results: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 6 months. The percentages of CLH covered were 74.88 ± 8.66% for CTG and 70.76 ± 9.81% for CTG+R (p>0.05). The estimated root coverage was 91.91 ± 17.76% for CTG and 88.64 ± 11.9% for CTG+R (p>0.05). Conclusion: Within the limits of the present study, it can be concluded that both procedures provide comparable soft tissue coverage. The presence of the glass ionomer restoration may not prevent the root coverage achieved by CTG. [source] Mechanical non-surgical treatment of peri-implantitis: a double-blind randomized longitudinal clinical study.JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2009I: clinical results Abstract Background: Peri-implantitis is a frequent finding in patients with dental implants. The present study compared two non-surgical mechanical debridement methods of peri-implantitis. Material and Methods: Thirty-seven subjects (mean age 61.5; S.D±12.4), with one implant each, demonstrating peri-implantitis were randomized, and those treated either with titanium hand-instruments or with an ultrasonic device were enrolled. Data were obtained before treatment, and at 1, 3, and 6 months. Parametric and non-parametric statistics were used. Results: Thirty-one subjects completed the study. The mean bone loss at implants in both groups was 1.5 mm (SD ±1.2 mm). No group differences for plaque or gingival indices were found at any time point. Baseline and 6-month mean probing pocket depths (PPD) at implants were 5.1 and 4.9 mm (p=0.30) in both groups. Plaque scores at treated implants decreased from 73% to 53% (p<0.01). Bleeding scores also decreased (p<0.01), with no group differences. No differences in the total bacterial counts were found over time. Higher total bacterial counts were found immediately after treatment (p<0.01) and at 1 week for ultrasonic-treated implants (p<0.05). Conclusions: No group differences were found in the treatment outcomes. While plaque and bleeding scores improved, no effects on PPD were identified. [source] Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: A 2-year follow-up randomized-controlled clinical trialJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2009Mauro Pedrine Santamaria Abstract Background: The aim of this study was to evaluate the 2-year follow-up success of the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap (CAF) alone or in combination with a resin-modified glass ionomer restoration (CAF+R). Material and Methods: Sixteen patients with bilateral Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects received either CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at the baseline and 6, 12 and 24 months after the treatment. Results: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 2 years. The percentages of CLH covered were 51.57 ± 17.2% for CAF+R and 53.87 ± 12.6% for CAF (p>0.05). The estimated root coverage was 80.37 ± 25.44% for CAF+R and 83.46 ± 20.79% for CAF (p>0.05). Conclusion: Within the limits of the present study, it can be concluded that both procedures provide acceptable soft tissue coverage after 2 years, with no significant differences between the two approaches. [source] Bleeding on probing differentially relates to bacterial profiles: the Oral Infections and Vascular Disease Epidemiology StudyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2008Ryan T. Demmer Abstract Aim: Various bacterial species are differentially prevalent in periodontal health, gingivitis or periodontitis. We tested the independent associations between three bacterial groupings and gingival inflammation in an epidemiological study. Material and Methods: In 706 Oral Infections and Vascular Disease Epidemiology Study (INVEST) participants 55 years, bleeding on probing (BoP), pocket depth (PD) and subgingival plaque samples (n=4866) were assessed in eight sites per mouth. Eleven bacterial species were quantitatively assayed and grouped as follows: (i) aetiologic burden (EB, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia); (ii) putative burden (PB, Campylobacter rectus, Eikenella corrodens, Fusobacterium nucleatum, Micromonas micros, Prevotella intermedia); (iii) health-associated burden (HAB, Actinomyces naeslundii, Veillonella parvula). Results: After mutual adjustment for EB, PB and HAB, the BoP prevalence increased by 45% ( p<0.0001) across increasing quartiles of EB while BoP decreased by 13% ( p<0.0001) across increasing quartiles of HAB. Mean PD increased 0.8 mm and decreased 0.3 mm from the first to fourth quartiles of EB (p<0.0001) and HAB ( p<0.0001), respectively. Among 1214 plaque samples with fourth quartile EB, 60% were collected from sites with PD 3 mm. Conclusion: Bacterial species believed to be aetiologically related to periodontitis were associated with BoP in sites with minimal PD and/or attachment level (AL). Species presumed to be associated with periodontal health demonstrated inverse associations with BoP. [source] Interleukin-1 gene polymorphisms and experimental gingivitisJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2003Søren Jepsen Abstract Background: Recently, an association between the severity of periodontitis and specific variations in the interleukin-1 (IL1) , and , genes has been demonstrated. Aim: The purpose of this study was to evaluate the relationship of the IL1 genotype to the development of experimental gingivitis. Materials and Methods: Twenty young adult subjects presenting with healthy gingival conditions participated after giving their informed consent. The group included 10 risk genotype positive (P+) and 10 risk genotype negative (P,) individuals. The IL1 genotypes were determined on DNA samples from peripheral blood using PCR-RFLP analyses for the IL1, and IL1, polymorphisms. Experimental gingivitis was allowed to develop in two posterior sextants per subject. Bleeding on probing (BOP%) and gingival crevicular fluid volume (GCF) were assessed at baseline and days 2, 7, 9, 14, 16 and 21. The day 21 results for BOP and GCF as well as the rate of increase of these parameters , mean area under the curve (AUC) and mean increase per day (slope) , were evaluated using risk analyses for IL1 genotype, smoking status and gender. Results: Experimental gingivitis developed with a gradual increase in BOP scores and GCF values (expressed as Periotron units=PU) from baseline to day 21 (BOP, P+: 0.5 to 26.0%; P,: 1.0 to 28.1%; GCF, P+: 36.8 to 138.5 PU, P,: 43.1 to 143.4 PU). No significant risk was associated with P+ and P, for day 21 results, AUC or slope. Conclusion: The results of this study failed to provide evidence that the IL1 risk genotype was associated with higher GCF volume and percentage BOP during the development of experimental gingivitis. Zusammenfassung Hintergrund: Kürzlich ist eine Beziehung zwischen dem Schweregrad von Parodontitis und speziellen Varianten der Interleukin-1 (IL1),- und -,-Gene gezeigt worden. Zielsetzung: Untersuchung des Zusammenhanges zwischen dem ILl-Genotyp und der Entwicklung einer experimentellen Gingivitis. Material und Methoden: 20 junge Erwachsene mit gesunden parodontalen Verhältnissen, von denen 10 für den Risikogenotyp positiv (P+) und 10 negativ (P-) waren, nahmen an der Studie teil, nachdem sie ihr Einverständnis dazu gegeben hatten. Die IL1 -Genotypen wurden aus DNS-Proben aus peripherem Blut mittels PCR-RFLP-Analyse auf ILl,- und IL1/,-Polymorphismen untersucht. In 2 Seitenzahnsextanten ließ jeder Proband eine experimentelle Gingivitis entwickeln. Bluten auf Sondieren (BOP%) und Sulkiksfiüssigkeitsvolumen (SFV) wurden zu Beginn der Studie und nach 2, 7, 9, 14, 16 und 21 Tagen bestimmt. Sowohl die Ergebnisse für BOP und SFV an Tag 21 als auch die Zunahme dieser Werte , mittlere Fläche unter der Kurve (AUC) und mittlere Zunahme pro Tag (Steigung) , wurden mittels Risikoanalyse fur IL1 -Genotyp, Rauchen und Gescnlecht bestimmt. Ergebnisse: Die experimentelle Gingivitis entwickelte sich mit einem stetigen Anstieg der BOP- und SFV-Werte (ausgedrückt als Periotroneinheiten=PU) vom Beginn der Studie bis zum 21. Tag (BOP, P+: 0,5% to 26,0%, P-: 1,0% to 28,1%; GCF, P+: 36,8 to 138,5 PU, P-: 43,1 to 143,4 PU). Mit P+und P- war kein signifikantes Risiko für die Werte am 21. Tag, die AUC oder die Steigung verbunden. Schlussfolgerung: Die Ergebnisse dieser Studie konnten keine Beziehung zwischen dem IL1 -Risikogenotype und erhöhtem SFV bzw. Anteil von Stellen mit BOP in % während der Entwicklung einer experimentellen Gingivitis zeigen. Résumé Contexte: Récemment, une association entre la sévérité de la parodontite et des variations spéifiques des gènes codant pour l'interleukin-1 (IL1) , et , a été démontrée. But: Cette étude se propose d'évaluer la relation entre le génotype IL1 dans le developpment de la gingivite expérimentale. Méthods: 20 jeunes sujets adultes présentant une bonne santé gingivale ont participé cette étude après consentement éclairé. Dans ce groupe, il y avait 10 individus à risque positif (P+) et 10 individus à génotype de risque négatif (P,). génotypes lL1 furent déterminés sur des échantillons d'ADN prélevés du sang périphérique par analyse en PCR-RFLP pour les polymorphismes d' IL1, et IL1,. On a laissé se développer une gingivite expérimentale sur 2 sextants postérieurs chez chaque sujet. Le saignement au sondage (BOP%) et le volume de fluide gingival (GCF) furent notes au départ et aux jours 2, 7, 9, 14, 16, et 21. Au vingt et unième jour, les résultats pour BOP et GCF ainsi que le taux d'augmentation de ces paramètres- La surface moyenne sous la courbe (AUC) et l'augmentation moyenne par jour (pente) - furent évalués par analyses du risque pour les génotypes IL1, le tabagisme et le sexe. Résultats: gingivite expérimentale se développa avec une augmentation graduelle des et scores de BOP et des valeurs de GCF (exprimées en unités Periotron=PU) du début de l'étude jusqu'au jour 21 (BOP, P+: 0.5%à 26.0%, P-: 1.0%à 28.1%; GCF, P+: 36.8 à 43.1 à 143.4 PU). Aucun risque significatif ne fut associe avec P+et P-ats à 21 jours, AUC ou la pente. Conclusion: -es résultats de cette étude n'ont pas pu donner de preuves d'associations entre le génotype de risque IL1 et un volume accru de GCF et le % BOP lors du t d'une gingivite expérimentale. [source] Comparison of the bleeding on marginal probing index and the Eastman interdental bleeding index as indicators of gingivitisJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2002D. S. Barendregt Abstract Aim: The purpose of the present study was to compare 2 indices, i.e., the Eastman interdental bleeding (EIB) index and the bleeding on marginal probing (BOMP) index. The comparison was made (a) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and (b) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment. For the present studies, subjects were selected without interdental recession of the gingival tissues. Methods experiment 1: In this experiment, 43 subjects having established moderate gingivitis were assessed using a random splitmouth design (1st and 3rd/2nd and 4th quadrant). Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other. Results experiment 1: The BOMP index showed a bleeding score of 84% and the EIB index of 87%. The significant correlation between plaque and gingival bleeding for the BOMP index (0.55) was higher than for the EIB index (0.44). Methods experiment 2: For this experiment, 25 subjects participated in an experimental gingivitis trial of the lower jaw. At baseline, first the BOMP index and immediately thereafter the EIB index were assessed at all approximal sites. Experimental gingivitis (EG) was carried out in one randomly assigned quadrant and as a treatment modality only floss was used in the other (FL). Results experiment 2: In the EG quadrant, the BOMP index increased to 69% and the EIB index to 73%. Both indices showed a significant correlation with plaque; 0.60 and 0.64 respectively. In the FL quadrant, the BOMP index increased to 38% and the EIB index to 30%. No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant. Conclusion: The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable. Zusammenfassung Ziel: Der Zweck der vorliegenden Studie war es, die 2 Indizes, den Eastman Interdental Bleeding (EIB) Index und den Bleeding On Marginal Probing (BOMB) Index zu vergleichen. Der Vergleich erfolgte. (A) hinsichtlich des provozierten Blutungsgrades und der Relation zwischen Plaque und natürlicher Gingivitis sowie: (B) bezüglich der Fähigkeit dieser 2 Methoden hinsichtlich des Nachweises von Unterschieden zwischen der Entwicklung einer experimentellen Gingivitis in einer Kontrollgruppe und einer Gruppe in der die Ausbildung einer gingivalen Entzündung durch die Behandlung unterdrückt wurde. Für die vorliegende Studie wurden Personen ohne interdentale Gingivarezession ausgewählt. Methoden Experiment 1: Bei diesem Experiment wurden 43 Personen mit etablierter moderater Gingivitis nach einem randomisierten Splitmouth-Design untersucht (1. Und 3./2. Und 4. Quadrant). Die Plaque wurde an allen approximalen Flächen bestimmt und anschließend wurde BOMP-Index in der einen Hälfte des Gebisses und der EIB-Index in der anderen erhoben. Ergebnisse Experiment 1: Der BOMP-Index zeigte einen Blutungswert von 84% und der EIB-Index einen von 87%. Die signifikante Korrelation zwischen der Plaque und einer gingivalen Blutung war für den BOMP-Index (0.55) höher als für den EIB-Index (0.44). Methoden Experiment 2: Für diese Experiment wurde bei 25 Personen eine experimentelle Gingivitis im Unterkiefer erzeugt. Bei der Eingangsuntersuchung wurde an allen Approximalflächen zuerst der BOMP-Index und sofort anschließend der EIB-Index erhoben. Die experimentelle Gingivitis (EG) wurde in einem randomisiert bestimmten Quadranten erzeugt und als Behandlungsart wurde im anderen Quadranten nur Zahnseide (FL) verwendet. Ergebnisse Experiment 2: Im EG-Quadranten stiegen der BOMP-Index auf 69% und der EIB-Index auf 73% an. Beide Indizes zeigten eine signifikante Korrelation mit der Plaque, die bei 0.60 bzw. 0.64 lag. Im FL-Quadranten stiegen der BOMP-Index auf 38% und der EIB-Index auf 30% an. Zwischen beiden Gingivitis-Indizes und der Plaquemenge, die im FL-Quadranten vorhanden war, gab es keine signifikante Korrelation. Schlussfolgerung: Die Möglichkeit mit dem BOMP-Index und den EIB-Index das Niveau der gingivalen Entzündung zu Bestimmen scheint vergleichbar zu sein. Résumé But: Le but de cette étude a été de comparer 2 indices, c-à-d. l'indice du saignement interdentaire d'Eastman (EIB) et l'indice du saignement au sondage marginal (BOMP). La comparaison a été effectuée (a) en termes de saignement provoqué et de relation avec la plaque dentaire dans la gingivite naturelle et (b) sur l'aptitude de ces 2 méthodes à détecter des différences lors du dévelopment d'une gingivite expérimentale dans un groupe contrôle et dans un groupe test dont le dévelopement de l'inflammation gingivale a été entravé par un traitement. Pour ces études, des sujets qui ne présentaient pas de récession interdentaire ont été sélectionnés. Méthodes, expérience 1: Dans la première expérimentation, 43 sujets étant porteurs d'une gingivite modérée ont été enregistrés en utilisant un modèle de bouche divisée au hasard (1er et 3ième quadrants VS 2ième et 4ième quadrants). La plaque dentaire a été estimée sur tous les sites interproximaux. Résultats expérience 1: L'indice BOMP a ensuite été relevé sur une partie de la bouche et l'indice EIB sur l'autre. L'indice BOMP a eu un score de 84% et l'EIB de 87%. La corrélation significative entre la présence de plaque dentaire et le saignement gingival était pour l'indice BOMP de 0.55, supérieur donc à celui de l'EIB qui était de 0.44. Méthodes expérience 2: Lors de la seconde expérience, 25 sujets ont participéà une gingivite expérimentale au niveau de la mandibule. Lors de l'examen de départ l'indice BOMP a été relevé en premier suivi de celui de l'EIB au niveau de tous les sites interproximaux. La gingivite expérimentale (EG) a été effectuée sur un quadrant choisi de manière randomisée et un traitement avec de la soie dentaire uniquement a été utilisé dans l'autre (FL). Résultats expérience 2: Dans le quadrant avec EG l'indice BOMP atteignait 69% et l'indice EIB à 73%. Les deux indices avaient une corrélation significative avec la plaque dentaire, respectivement de 0.60 et 0.64. Dans le quadrant FL, l'indice BOMP grimpait à 38% et l'indice EIB à 30%. Aucune corrélation significative entre les deux indices de gingivite et la quantité de plaque n'a été trouvé dans le quadrant FL. Conclusions: L'aptitude des indices BOMP et EIB à mesurer le niveau d'inflammation gingivale semble comparable. [source] The periodontal abscess (I).JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2000Clinical, microbiological findings Background/aims: Little information is available regarding the diagnosis and microbiology of periodontal abscesses. The aim of this descriptive clinical and microbiological study was to provide more information in order to help in the characterisation of the periodontal abscess associated to periodontitis. Method: 29 consecutive patients with a periodontal abscess were studied by the assessment of clinical variables, including both subjective (pain, edema, redness and swelling) and objective (bleeding on probing, suppuration, probing pocket depth, tooth mobility and cervical lymphadenopathy) parameters. Microbiological samples were taken for anaerobic microbiology and processed by means of culture. Systemic involvement was also studied through the analysis of blood and urine samples using conventional laboratory standards. Results: 62% of the abscesses affected untreated periodontitis patients, and 69% were associated with a molar tooth. More than 75% of the abscesses had moderate-severe scores related to edema, redness and swelling, and 90% of the patients reported pain. Bleeding occurred in all abscesses, while suppuration on sampling was detected in 66%. Mean associated pocket depth was 7.28 mm, and 79% of teeth presented some degree of mobility. Cervical lymphadenopathy was seen in 10% of patients, while elevated leucocyte counts were observed in 31.6%. The absolute number of neutrophils was elevated in 42% of the patients. High prevalences of putative periodontal pathogens were found, including Fusobacterium nucleatum, Peptostreptococcus micros, Porphyromonas gingivalis, Prevotella intermedia and Bacteroides forsythus. Conclusions: The periodontal abscess has clear clinical characteristics and is usually associated with severe periodontal destruction. This condition may cause systemic involvement and the lesion generally has a large bacterial mass with a high prevalence of well-recognised periodontal pathogens. [source] HELICOBACTER INFECTION IN CHILDREN WITH APPENDICITIS AND LACTOSE INTOLERANCEJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000Eva J. Soelaeman Helicobacter pylori eradication has been debated. Most investigators do not recommended treating the infection except in severe case. We report a unique case: H. pylori infection with appendicitis and lactose intolerance. Case report: A 6 year old girl was brought to children and maternity Hospital Harapan Kita due to abdominal pain and vomiting. She had 6- month history of epigastric pain. In the past 2 days, she suffered from abdominal pain arround Mc. Burney area. On physical examination, she was in pain. Her weight was 19 Kg. Vital signs were normal. Findings in heart, lung and extremities were also normal. Abdomen: severe pain in the epigastric and Mc. burney area.Laboratory investigations showed hemoglobin 12 g/dl, leukocyte 12800/ul. Platelets 289000/ul. Bleeding and clotting time were normal. Abdominal ultrasonography revealed inflammation of appendix with 9-mm diameter. Stool examination was normal.Appendectomy was done at the same time with esofagogastroduodenoscopy (EGD). On EGD, we found moderete anthral gastritis. On histopathological examination, we found H. pylori at antral of the stomach. Breath hydrogen test was positive. After H. pylori eradication and milk avoidance, abdominal pain has never occurred. Conclusion: Abdominal: pain is not specific for H. pylori infection. The pain caused by many diseases including H. pylori infection. In our case, we can control abdominal pain by H. pylori eradication. [source] Twelve-month outcomes and predictors of very stable INR control in prevalent warfarin usersJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2010D. M. WITT Summary., Background:, For patients on warfarin therapy an international normalized ratio (INR) recall interval not exceeding 4 weeks has traditionally been recommended. For patients whose INR values are nearly always therapeutic, less frequent INR monitoring may be feasible. Objective:, To identify patients with stable INRs (INR values exclusively within the INR range) and comparator patients (at least one INR outside the INR range), compare occurrences of thromboembolism, bleeding and death between groups, and identify independent predictors of stable INR control. Methods:, The study was a retrospective, longitudinal cohort study using data extracted from electronic databases. Patient characteristics and risk factors were entered into multivariate logistic regression models to identify variables that independently predict stable INR status. Results:, There were 533 stable and 2555 comparator patients. Bleeding and thromboembolic complications were significantly lower in stable vs. comparator patients (2.1% vs. 4.1% and 0.2% vs. 1.3%, respectively; P < 0.05). Independent predictors of stable INR control were age >70 years, male gender and the absence of heart failure. Stable patients were significantly less likely to have target INR ,3.0 or chronic diseases. Conclusion:, A group of patients with exclusively therapeutic INR values over 12 months is identifiable. In general, these patients are older, have a target INR <3.0, and do not have heart failure and/or other chronic diseases. Our findings suggest that many patients whose INR values remain within the therapeutic range over time could be safely treated with INR recall intervals >4 weeks. [source] Major differences in bleeding symptoms between factor VII deficiency and hemophilia BJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2009F. BERNARDI Summary.,Background:,The autosomally-inherited factor VII (FVII) deficiency and X-linked hemophilia B offer an attractive model to investigate whether reduced levels of FVII and FIX, acting in the initiation and amplification of coagulation respectively, influence hemostasis to a different extent in relation to age and bleeding site. Methods:,Hemophilia B patients (n = 296) and FVII-deficient males (n = 109) were compared for FVII/FIX clotting activity, F7/F9 genotypes and clinical phenotypes in a retrospective, multi-centre, cohort study. Results:,Major clinical differences between diseases were observed. Bleeding occurred earlier in hemophilia B (median age 2.0 years, IR 0.9,5.0) than in FVII deficiency (5.2 years, IR 1.9,15.5) and the bleeding-free survival in FVII deficiency was similar to that observed in ,mild' hemophilia B (P = 0.96). The most frequent disease-presenting symptoms in hemophilia B (hematomas and oral bleeding) differed from those in FVII deficiency (epistaxis and central nervous system bleeding). Differences were confirmed by analysis of FVII-deficient women. Conclusions:,Our data support the notion that low FVII levels sustain hemostasis better than similarly reduced FIX levels. On the other hand, minute amounts of FVII, differently to FIX, are needed to prevent fatal bleeding, as indicated by the rarity of null mutations and the associated life-threatening symptoms in FVII deficiency, which contributes towards shaping clinical differences between diseases in the lowest factor level range. Differences between diseases are only partially explained by mutational patterns and could pertain to the specific roles of FVII and FIX in coagulation phases and to vascular bed-specific components. [source] D-dimer levels during delivery and the postpartumJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2005M. EPINEY Summary.,Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. Objectives: To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. Patients and methods: After uncomplicated pregnancies, 150 women delivering at term either vaginally (n = 100) or by cesarean section (n = 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. Results: There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL,1 at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL,1. Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. Conclusion: Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL,1, DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery. [source] Occurrence and relapse of bleeding from duodenal ulcer: respective roles of acid secretion and Helicobacter pylori infectionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2001G. Capurso Background: Helicobacter pylori infection, gastric acid hypersecretion and NSAID consumption may cause peptic ulcer. Aim: To investigate the respective roles of H. pylori and acid secretion in bleeding duodenal ulcer. Patients and methods: A total of 99 duodenal ulcer patients were referred for evaluation of acid secretion: seven with Zollinger,Ellison Syndrome; 14 with hypersecretory duodenal ulcer, defined by the coexistence of elevated basal acid output and pentagastrin acid output; and 78 duodenal ulcer patients with normal acid output. All non-Zollinger,Ellison Syndrome patients were H. pylori -positive and cured of infection. All patients were followed-up for a 36-month period, to assess the occurrence of bleeding episodes. Results: Twenty-nine patients had at least one bleeding episode in the 4 years before the study. Bleeding was more frequent in males and in patients on NSAIDs. The mean basal acid output was not higher among bleeders. In the 21 patients (14 hypersecretory duodenal ulcer, seven Zollinger,Ellison Syndrome) with basal acid output > 10 meg/h and pentagastrin acid output > 44.5 meg/h, the risk of bleeding was higher (OR 6.5; 95% CI: 2,21). In the follow-up period, three out of 83 (3.3%) non-Zollinger,Ellison Syndrome patients had a H. pylori -negative duodenal ulcer with bleeding. The risk of bleeding after H. pylori cure was not higher in hypersecretory duodenal ulcer patients (P > 0.3), nor among patients with previous bleeding episodes (P > 0.2). Conclusions: In H. pylori -positive duodenal ulcer patients, the coexistence of elevated basal acid output and pentagastrin acid output leads to a sixfold increase in the risk of bleeding. After H. pylori cure, gastric acid hypersecretion is not a risk factor for bleeding. However, duodenal ulcer recurrence with bleeding may occasionally occur in patients cured of H. pylori, even if acid output is normal. [source] Development and research in idiopathic thrombocytopenic purpura: An inflammatory and autoimmune disorderPEDIATRIC BLOOD & CANCER, Issue S5 2006Paul Imbach MD Abstract Bleeding and isolated thrombocytopenia in idiopathic thrombocytopenic purpura (ITP) are phenomena of a transient or long-term disturbed immune response. Since 1980, ITP has become a model for targeted therapeutic immunomodulation with still unclear mechanisms of action. The systematic analysis of ITP aims to determine more clearly defined patient subgroups for targeted therapy and to explore the complex immune disturbances in this autoimmune disorder. Pediatr Blood Cancer 2006;47:685,686. © 2006 Wiley-Liss, Inc. [source] Difficult-to-Control BleedingPEDIATRIC DERMATOLOGY, Issue 5 2009Jane S. Bellet M.D. The surgery was complicated by unexpected difficult-to-control bleeding in the operating room. Numerous attempts to obtain hemostasis were unsuccessful including the use of local anesthetic containing epinephrine, direct pressure, wall suction, monopolar electrocautery using different tip sizes, sponge sticks, and Gelfoam®. Finally bleeding was contained using a suction-electocautery unit frequently used by otolaryngology. This article reviews the usual causes of unexpected bleeding in the pediatric population and both familiar and unfamiliar methods to control operative bleeding. [source] Pulmonary hemorrhage/hemoptysis in childrenPEDIATRIC PULMONOLOGY, Issue 6 2004Simon Godfrey MD Abstract Pulmonary hemorrhage and hemoptysis are uncommon in childhood, and the frequency with which they are encountered by the pediatric pulmonologist depends largely on the special interests of the center to which the child is referred. In those centers caring for children with cystic fibrosis or congenital heart disease, these will be by far the most common causes of hemoptysis. Other causes of hemoptysis are far less common, such as bleeding from localized lesions in the upper airway or tracheobronchial tree. Even less common is bleeding into the lungs as part of a systemic disease, usually with renal involvement (pulmonary-renal syndromes), such as systemic lupus erythematosis or Goodpasture's syndrome. Bleeding into the lungs in children with a bleeding diathesis probably only occurs in immunosuppressed children after transplantation. When no other cause is found for pulmonary hemorrhage, the presumed diagnosis is idiopathic pulmonary hemosiderosis. This review discusses the various causes of hemoptysis and pulmonary hemorrhage, and the appropriate investigations to aid in determining the correct diagnosis. The management and prognosis of idiopathic pulmonary hemosiderosis, based on cumulative experience from published reports, are considered in more detail. Pediatr Pulmonol. 2004; 37:476,484. © 2004 Wiley-Liss, Inc. 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